Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical Students

Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical
Students
Nidhi Nagori*, Ashok Vala**, Bharat Panchal***, Imran Ratnani*, Kinjal Vasava*
*Resident Doctor, **Associate Professor, ***Professor, Department Of Psychiatry, Government Medical College, Bhavnagar
Abstract: Objective: Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or
behaviours regarding computer use and Internet access that lead to impairment or distress in individual’s
psychological state. This study was aimed to assess the frequency of internet addiction and its possible association
with anxiety severity and quality of life among medical students. Methods: This was an observational, cross sectional,
single-centred, self-assessable questionnaire based study administrated among 525 consenting medical students.
The participants were assessed by proforma containing demographic details,variables related with internet use,
questionnaires of IAT (Internet Addiction Test for Internet Use), BAI (Beck’s Anxiety Inventory) and WHOQOL-BREF
(World health organization quality of life assessment scale). Statistical data were analysed by Graph Pad InStat
version 3.06 using Chi–square test and Mann-Whitney test. Results: Frequency of problematic users among medical
students was 9.3 % with frequency of internet addiction 0.9%.Participants with problematic internet use were likely
to experience high severity of anxiety (p<0.0001) and poorer quality of life in psychological (p= 0.01) and
environmental domain (p=0.03). Conclusion: Participants with problematic internet use were more likely to
experience anxiety symptoms and poor quality of life and vice a versa. [Dr.Nidhi N NJIRM 2016; 7(5):9-13]
Key Words: Anxiety, Internet Addiction, Quality of Life
Author For Correspondence: Dr. Nidhi Nagori, C-303, Meghna Complex, Gandhi Kutir, U.M. Road, Surat -395017
(Gujarat).E- E-Mail: nidhi.nagori12@gmail.com
Introduction: There has been an explosive growth in present in the preceding 6 months. She further
the use of internet not only in India but also divided Internet addiction into 5 subtypes depending
worldwide in the last decade. There were about 243 on the particular component of use to which it was
million active internet users in urban India in July directed addiction, namely: (1) cybersexual addiction;
20141 as compared to 149 million in 20132 and 45 (2) cyber-relational addiction; (3) net compulsions; (4)
million in 20083. The internet is used by some to information overload; and (5) computer addiction 6.
facilitate research, to seek information, for
interpersonal communication, and for business Another important researcher in this area is Mark
transactions. On the other hand, it can be used by Griffiths7 who suggested the following six basic
some to indulge in pornography, excessive gaming, components of Internet addiction. His components
chatting for long hours, and even gambling. There are based on the general criteria of DSM IV: 1.Salience
have been growing concerns worldwide for what has 2.Mood modification 3.Tolerance 4. Withdrawal
been labeled as “INTERNET ADDICTION” and this term symptoms 5.Conflict and 6.Relapse.
was first introduced by Dr. Ivan Goldberg4 in 1995 to
describe ‘pathological and compulsive use of Previous studies8 about Internet addiction have
internet’. investigated several associated psychological variables
such as shyness, loneliness, self-consciousness,
5
Kimberly Young , a well know researcher in this field, anxiety, depression, and interpersonal relations.
describes Internet addiction as follows: “Internet
addiction is defined as any online-related, compulsive One is at greater risk of Internet addiction if 9:
behaviour which interferes with normal living and •Suffer from anxiety as some may use the Internet to
causes severe stress on family, friends, loved ones, distract self from their worries and fears.
and one's work environment. Internet addiction has •Any other addictions :Many Internet addicts suffer
been called Internet dependency and Internet from other addictions, such as drugs, alcohol,
compulsivity. By any name, it is a compulsive gambling, and sex.
behaviour that completely dominates the addict's •Poor social support : Internet addicts often use social
life.” Young modified the DSM-IV diagnostic criteria networking sites, instant messaging, or online gaming
for pathological gambling to construct diagnostic as a safe way of establishing new relationships and
criteria for pathological Internet use, which she more confidently relating to others.
defined as 5 or more of 8 characteristic symptoms

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 Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical Students
•An unhappy person :Some might be wondering
where they fit in and the Internet could feel more
comfortable than real-life friends.
Internet addiction results in personal, family,
academic, financial, and occupational problems that
are characteristic of other addictions. Individuals
suffering from Internet addiction spend more time in
solitary seclusion, spend less time with real people in
their lives, and are often viewed as socially awkward.
Arguments may result due to the volume of time
spent on-line. Those suffering from Internet addiction
may attempt to conceal the amount of time spent on-
line, which results in distrust and the disturbance of
quality in once stable relationships10.
Some suffering from Internet addiction may create
on-line personas or profiles where they are able to
alter their identities and pretend to be someone other
than himself or herself. Those at highest risk for
creation of a secret life are those who suffer from
low-self esteem feelings of inadequacy, and fear of
disapproval. Such negative self-concepts lead to
clinical problems of depression and anxiety.
Many persons who attempt to quit their Internet use
experience withdrawal including: anger, depression,
relief, mood swings, anxiety, fear, irritability, sadness,
loneliness, boredom, restlessness, procrastination,
and upset stomach. Being addicted to the Internet
can also cause physical discomfort or medical
problems such as: Carpal Tunnel Syndrome, dry eyes,
backaches, severe headaches, eating irregularities,
(such as skipping meals), failure to attend to personal
hygiene, and sleep disturbance11,12.
A number of studies have been conducted across the
world, especially among adolescents with respect to
internet addiction. In studies that focus on younger
people, prevalence of internet addiction estimates
range from 0.9 to 38%.13,14,15,16,17
This study is a preliminary step toward understanding
the extent of internet addiction among college
students in India. By studying the association of
internet usage and its effects on human behavior, we
can formulate interventions like setting boundaries
and detecting early warning signs of underlying
psychopathology at the earliest.
The objectives of present study is to assess frequency
of Internet Addiction and association of Anxiety
severity and quality of life with Internet Addiction
NJIRM 2016; Vol. 7(5) September-October
among medical students and also to know about
corelation between Anxiety severity with severity of
Internet Addiction among medical students and to
compare above stated parameters among medical
students with Internet Addiction and without Internet
Addiction.
Methods: In the present study 525 students were
enrolled from Medical College including MBBS
students, interns and postgraduate students from
time period from October 2014 –March 2015 after
prior approval from local ethics committee
(Institutional Review Board / Human Ethics
Committee ) for conducting the study.
Purpose of study was explained to all the participants
and written informed consent was taken from them.
They were given a proforma containing details of
demographics (name, age, gender, weight, height),
designation, purpose of using the internet (by
choosing among the options like education,
entertainment, news, gaming or social
networking),monthly total expenditure, money spent
per month on internet, place of access (home,
cybercafé, or college ), the time of day when the
internet is accessed the most , the average duration of
use per day, time spent on other extracurricular
activities per day and addiction of any
substance(tea/coffee/others). Presence or absence of
past history and family history of psychiatric illness
was also included in the proforma.
The proforma further included the self-assessable
questionnaire which was based on following scales.
The Internet Addiction Test (IAT; Young, 1998)18which
is a 20-item 5-point likert scale that measures the
severity of self-reported compulsive use of the
internet. Total internet addiction scores were
calculated, with possible scores for the sum of 20
items ranging from 20 to 100.
According to Young's criteria, total IAT scores 20-49
represent average users with complete control of
their internet use, scores 40-79 represent over-users
with frequent problems caused by their internet use,
and scores 80-100 represent internet addicts with
significant problems caused by their internet use.
2) The Beck Anxiety Inventory (BAI),19 created by
Aaron T. Beck, MD, and colleagues, is a 21-item
multiple-choice self-report inventory that measures
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 Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical Students
the severity of an anxiety in adults and adolescents. Problematic internet users were using internet for
The values for each item are summed yielding an longer duration of years and spend more hours daily
overall or total score for all 21 symptoms that can using internet than normal users.
range between 0 and 63 points.The values for each
item are summed yielding an overall or total score for There was a statistically significant relationship
all 21 symptoms that can range between 0 and 63 between the total monthly expenditure and monthly
points. A total score of 0 - 7 is interpreted as a cost of internet services among the problematic
"Minimal" level of anxiety; 8 - 15 as "Mild"; 16 -25 as internet users which was of the higher cost compared
"Moderate", and; 26 - 63 as "Severe". to non-problematic internet users.
3) WHOQOL-BREF20is the short version of the
WHOQOL 100 . There was significant association between high speed
of internet and problematic internet use was seen in
It is a self-report questionnaire that contains 26 items our study, high speed helps in fast downloading and
of WHOQOL-BREF (World Health Organization Quality easy accessibility so one may become more prone to
of Life) assessment scale for assessment of person’s internet addiction.
quality of life in physical health, psychological, social
relationship and environment domains. A higher score Participants with problematic internet use were likely
indicates a higher QOL. Qualitative data were to experience high severity of anxiety (p<0.0001).
expressed as percentages and quantitative data were Severity of anxiety is positively correlated with
expressed as mean ± standard deviation. The internet addiction (r2= 0.085, p<0.0001).
statistical analysis was done with Graph Pad. InStat
version 3.06 (San Diego, California, US). The participants with problematic internet use had a
poorer quality of life in psychological (p= 0.01) and
Proportions of participants were compared by using environmental domain (p=0.03) of WHOQOL-BREF as
Chi-square test while scores of IAT, BECK’S Anxiety compared to non- problematic group.
Inventory and WHOQOL-BREF was compared by using
Mann-Whitney test or Kruskal-Wallis test followed by Table 1 : Overall Analysis To Find Out Proportion Of
Dunn’s post-hoc multiple comparisons. A p value of < Study Subjects Falling In The Category Of Internet
0.05 was considered statistically significant. Statistical Addicts On The Basis Of Scoring System Adapted For
co-relation between internet addiction and above Study (N=525)
stated psychiatric variables were assessed by Scoring Pattern No. of Males Females Perce
spearman’s rank correlation. Interval Student (245) (280) ntage
* (525) (%)
Result: Participants were grouped into 2 groups; Non- <20 Less than 180 62 118 34.3
problematic use of internet (IAT score < 50 i.e. average %
average online users and less than that) and 20-49 Average 296 150 146 56.4
Problematic use of internet (IAT score ≥ 50 i.e user %
moderate internet users and internet addicts). 50-79 Moderate 44 30 14 8.4%
user /
Frequency of problematic users among students was Possible
9.3 % with frequency of internet addiction 0.9%.Males addict
were more likely to experience internet addiction 80- Addict 05 03 02 0.9%
than females. 100
*Scoring is based on Internet Addiction Test (IAT)
The main purpose of using the internet in medical
students were for social networking (81.5%) and for Discussion: Our study showed that 44 out of 525
education (81.3%) followed by entertainment (72.2%) participants (8.4%) were at risk with moderate use of
and then the other purposes. About 96.2 % of the internet and five out of 525 participants (0.9%) were
medical students were using mobile phones to access addicted users, so 49 out of 525 participants (9.3%)
the internet. were considered problematic internet users with
frequency of internet addiction 0.9%. In the studies

NJIRM 2016; Vol. 7(5) September-October eISSN: 0975-9840 pISSN: 2230 - 9969 11
 Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical Students
conducted by Goel et al15and VenkataVenu Gopala in other studies was found between 3.5% -
RajuSrijampana et al16 , it was also found that the 17.2%17,21.It must be noted that comparing these
prevalence of internet addicts was 0.7% and 0.4% studies was a difficult task because of differences in
respectively among students which is consistent with study populations, applied tools, cut off points and
our own results.The prevalence of internet addiction differences in social and cultural contexts.
Table 2: Association Of Internet Addiction (Based On Table 3 : Association Of Severity Of Anxiety (BAI
IAT Scores) With Anxiety Severity (BAI Scores) And Scores) With Internet Addiction (IAT Scores) And
Quality Of Life (WHOQOL-BREF Score). Quality Of Life(WHOQOL-BREF Score).
Non Problematic BAI < 8 BAI ≥ 8
Problematic use of N = 313 N = 212 P value
use of Internet Internet p value IAT 24.37 ± 14.28 33.11 ± 17.40 p< 0.0001
IAT Score < 50 IAT Score ≥
N=476 50 WHOQOL-BREF
N=49 Physical health 56.02 ± 9.42 52.84 ± 10.32 p = 0.0025
BAI Score 6.45± 5.84 13.77±10.60 p<0.000
1 Psychological 62.67 ± 11.52 59.98 ± 11.74 p = 0.0088
WHOQOL-BREF
Physical health 54.98±9.65 52.33±10.60 p=0.08 Social 69.45 ± 14.42 63.63 ± 17.43 p < 0.0001
relationship
Psychological 61.99±11.44 57.65±13.21 p = 0.01 Environmental 72.54 ± 12.90 68.63 ± 13.30 p = 0.0025
Correlating the IAT score with BAI score in figure 1,
p < 0.05
Social 67.43±15.40 63.26±20.19 there is significant correlation between them (r2 =
relationship 0.085, p<0.0001).
p=0.03
Environmental 71.31±12.95 67.60±15.03
BAI SCORE

IAT SCORE

In consistent with earlier study16,Internet addiction
was found more frequent among males in our study
also and the problematic users were using internet for
prime purpose of social networking and
entertainment. In our study, we found that there was
significant association between internet addiction and
anxiety symptoms and a positive co-relation was also
seen between them. This finding is in consistent with
finding in other study22. The participants with
problematic internet use had a poorer quality of life in
psychological and environmental domain as
compared to non- problematic group and similar
finding was also seen in previous study23.Our study
suggested that as the severity of anxiety increases,
the chances of internet addiction also increases and
quality of life in all the domains of WHOQOL-BREF
decreases.
Conclusion: Participants with problematic internet use
are more likely to experience anxiety symptoms and
quality of life and vice a versa. As the severity of
anxiety increases, the chances of internet addiction
also increases and quality of life in all the domains of
WHOQOL-BREF decreases.
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 Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical Students
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Conflict of interest: None
Funding: None
Cite this Article as: Nidhi N, Ashok V, Bharat P,
Imran R, Kinjal V Association Of Anxiety And
Quality Of Life With Internet Addiction Among
Medical Students. Natl J Integr Res Med 2016;
7(5): 9-13
pISSN: 2230 - 9969 13